Fat-shaming in public health

Dr Isaac Warbrick, Director of the Taupua Waiora Centre for Māori Health Research at Auckland University of Technology (AUT), says societal and institutional racism needs to be challenged in the areas of nutrition, physical activity and weight loss.

Indigenous peoples in developed nations are more likely to be overweight, obese and disproportionately affected by the comorbidities and physical disorders associated with weight.

“In New Zealand, weight remains the primary focus for health interventions targeting Māori, with limited mention of psychological, spiritual or whānau well-being. Rather than improving health outcomes for Māori, weight and weight loss-centred approaches may actually cause harm,” he says.

“Initiatives based on indigenous knowledge are more relevant than those focused on weight loss.”

Dr Warbrick is an exercise physiologist at the School of Public Health and Psychosocial Studies at AUT.

He is the lead author of the paper, “The shame of fat-shaming in public health: Moving past racism to embrace indigenous solutions”, a conceptual article and literature review recently published in the international Public Health journal.

The paper examines perceptions of weight and racism towards Māori, who benefits from fat-shaming, New Zealand’s policy and practice regarding weight, and proposed indigenous solutions.

More than 40 years ago, British psychotherapist and social critic, Susi Orbach, argued that Fat is a Feminist Issue. The prominent book analysed the psychology of dieting and overeating in women, and the pressure on girls to feel dissatisfied with their physical appearance.

Dr Warbrick argues that fat is also a racism issue.

“Just as sexism-related stigma is compounded by weight anxiety, racism toward Māori is compounded by fat-shaming,” he says.

“Long before we reached the current alarming level of obesity, Māori were stigmatised, like many other colonised peoples, because of the colour of their skin, their beliefs and culture. Stigma is nothing new to Māori, so when we are told that we are fat and less productive because of our fatness, we are not surprised because we have been told the same thing, albeit for different reasons, for generations.”

Indigenous peoples are often presented as hapless and unable to engage in either individual or collective self-care. They also commonly experience racism and fat-shaming.

A previous study found that clinicians described Māori patients as non-compliant, which they attributed to Māori ignorance, poverty and self-destructiveness. In contrast, Māori patients described themselves as pursuing health, but most felt marginalised and had negative experiences accessing health services.

The New Zealand Health Survey 2017/18 shows that almost one in three adults are obese. Among Māori, 47 percent of adults and 17 percent of children are obese.

In response to health statistics, the ‘war on obesity’ in most developed countries has fuelled fear of being or becoming overweight at all levels of society. And, the market has benefitted greatly from this.

Dr Warbrick contends that health systems and the governments that fund them, who are faced with limited funding and resources, can redirect blame to individual failing. This diverts attention from policies that favour commercial interests over health.

“Individual or indigenous blame for ‘the weight issue’ has not led to any large-scale improvements in health outcomes or investment in indigenous solutions,” he says.

In New Zealand, indigenous evidence about what works for Māori communities has often been overlooked in favour of data from the global north, which rarely has indigenous analysis.

The government’s Healthy Eating Health Action (HEHA) strategy, which informs much of the public health work in this space, was framed around the World Health Organisation’s Ottawa Charter for Health Promotion, which contains no reference to indigenous peoples, their worldviews or aspirations.

A focus on BMI and weight seems to channel health promotion into the mono-cultural status quo.

“The near universal use of western-orientated outcome measures highlight an unwillingness of the health system to accept Māori knowledge at all levels and stages of health service provision,” says Dr Warbrick.

“We need indigenous-led solutions informed by indigenous knowledge”.

Indigenous solutions highlight the value of traditional knowledge, values and beliefs in addressing contemporary issues. The Atua Matua Māori health framework provides an alternative to weight-focused health promotion. Maunga ki te Tangata is another approach, which acknowledges the health-determining connection of individuals to their environment, social structures and family.

“A shift is needed from fat-shaming individuals and specific groups who are predominantly larger to understanding the systemic impacts of colonisation on the colonised,” says Dr Warbrick.

Taupua Waiora Centre for Māori Health Research

The Taupua Waiora Centre for Māori Health Research at AUT South Campus promotes Whānau Ora and positive health experiences for Māori. It aims to reduce inequities in health by improving evidence and knowledge that will enhance access and the use of health services, and promote positive outcomes and hauora for Māori whānau, hapū, iwi and communities.

AUT South Campus

AUT South Campus houses multiple research centres committed to improving the respective health of Māori, Pacific peoples, men, women and children. Together, they represent an emerging hub of ‘research that matters’ to Aotearoa and our region of The Pacific.